Collaboration is Key to Safely Transition Care in MM Following Cellular Therapy
Key Points
- Close collaboration and communication are crucial to safely transition patients who receive chimeric antigen receptor (CAR) T-cell therapy back to community oncology care.
- While cytokine release syndrome (CRS) and immune effector cell–associated neurotoxicity syndrome (ICANS) are limited to the first 2 to 4 weeks after CAR T therapy, longer-term risks such as cytopenias, infections, and hypogammaglobulinemia require ongoing monitoring.
- Emerging data support earlier use of cellular immunotherapies, with CAR T-cell therapy potentially favored over bispecific antibodies for select patients at first relapse.
As cellular therapies, such as CAR T-cell therapy and bispecific antibodies, move earlier in the multiple myeloma treatment paradigm, effective coordination between academic centers and community oncologists has become increasingly important. At the 2025 ASH Annual Meeting, Hamza Hashmi, MD, of Memorial Sloan Kettering Cancer Center, and Shreyas Kalantri, MD, of University of Louisville, discussed proactive communication strategies, adverse event (AE) risk, and promising data emerging from the conference.
The discussion highlighted the value of multidisciplinary care, using standardized handouts, detailed clinic notes, and post–CAR T management templates to be shared with community teams to guide ongoing monitoring and supportive care.
Although there is a risk of CRS and ICANS, they typically occur within the first 14 to 30 days after CAR T infusion, said Dr. Hashmi. The more clinically relevant AE concerns include prolonged cytopenias, infection risk, and hypogammaglobulinemia. To mitigate these risks, patients are routinely managed with antiviral prophylaxis for up to 12 months.
Of note, new and rare toxicities are emerging following CAR-T treatment, including Parkinsonian features, cranial nerve palsies, and CAR-T-associated enterocolitis. In these cases, patients are often followed every three months, with community oncologists educated on warning signs that should prompt referral back to an academic center for further evaluation and management.
Looking ahead, the panel emphasized the rapid evolution of cellular immunotherapy, with bispecific antibodies and CAR T-cell therapy increasingly considered in early relapse or even frontline settings.